| NPI | 1396170205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: IL 277003875) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209-010694) |
| 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: IL 209-010694) | |
| 163W00000X Registered Nurse (Licence: IL 041-358671) | |
| Enumeration Date | 2013-09-10 |
| Last Update Date | 2026-01-28 |